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HEART Insight:
doi: 10.1097/01.HEARTI.0000334393.19599.c7
Departments: Asked + Answered

A Panel Of Leading Cardiologists Tackles Your Questions

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Send your questions via e-mail to: HeartInsight@wolterskluwer.com (please include “Ask The Experts” in the subject line) or write to HEART INSIGHT at: 333 Seventh Avenue, 19th Floor, New York, NY 10001.

THIS INFORMATION IS PROVIDED AS AN EDUCATIONAL RESOURCE, AND IS NOT MEANT TO SUBSTITUTE FOR MEDICAL CONSULTATION OR CARE. ALL QUESTIONS ARE SUBJECT TO BE EDITED FOR CLARITY. NEITHER THE AMERICAN HEART ASSOCIATION NOR THE PUBLISHER GUARANTEES THAT EVERY QUESTION WILL BE PUBLISHED AND ANSWERED.

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TIA

Q What is a TIA, what causes it, how is it diagnosed and what is the recommended treatment?

A TIA, or “transient ischemic attack,” is sometimes called a “ministroke.” As with all strokes, TIA is an interruption of blood flow to the brain due to narrowing of one or more arteries to the brain. Unlike a full-blown stroke, TIA does not result in permanent brain injury — that is, symptoms such as vision loss, difficulty speaking or weakness on one side of the body are “transient” and typically last only a few minutes. However, TIA should be considered a warning sign that a full-blown stroke or heart attack is imminent within the next few minutes, hours or days. Anyone who has experienced a TIA should seek immediate medical attention. Typically, patients will be treated with anticlotting and cholesterol-lowering medications, but in some cases surgery may be needed to clear and open a clogged artery.

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Robert Adams, M.S., M.D.

Professor of Neuroscience, Medical University of South Carolina, Charleston

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Coronary Spasm

Q O'm a 58-year-old, physically fit, vegetarian female. My cholesterol levels were good, and my blood pressure has always been low, but I had a heart attack nearly a year ago that my cardiologist said was caused by a spasm. What would cause such a spasm, and how likely am I to have another one?

A coronary spasm occurs when the artery constricts and chokes off blood flow to the heart muscle. It's like a kink in a garden hose. The condition is more common in women than in men, and typically develops spontaneously near a cholesterol plaque, but can also occur without plaque buildup. Coronary spasm can cause chest pain (angina) at night or when you're at rest, abnormal heart rhythm or even a heart attack, if the constriction lasts long enough. Calcium channel blockers and nitroglycerin are effective for prevention and treatment. People who have experienced a coronary spasm should also keep cholesterol and blood pressure well controlled, and stop smoking.

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Patrick T. O'Gara, M.D., F.A.H.A.

Associate Professor of Medicine, Harvard Medical School, Boston

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Dental Health

Q Is it true that cavities and missing teeth contribute to heart attacks and strokes?

A It is unclear whether cavities and missing teeth are linked to heart attack and stroke, though dental health is an important factor in good health overall. If tooth decay (cavities) gets deep enough, the pulp (nerve) of the tooth will become infected, causing either chronic or acute infection (abscess) in the jawbone. Left untreated, gum disease (gingivitis) can eventually lead to periodontal disease and tooth loss. Some researchers believe that the bacterial infections that cause abscesses and periodontal disease can also promote the disease process that leads to heart attack and stroke, but more studies need to be done to establish a causal relationship.

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Peter B. Lockhart, D.D.S.

Chairman, Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC

© 2008 American Heart Association, Inc.

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